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Phacoemulsification compared with phacotrabeculectomy surgery: a within-person observational cohort study
Kazim Dhalla1, Simon Cousens2, Ian E Murdoch3,4
1Department of Ophthalmology, Comprehensive Community Based and Rehabilitation in Tanzania (CCBRT) - Hospital, Dar es Salaam, United Republic of Tanzania.
The British Journal of Ophthalmology
|April 19, 2017
Summary
Phacotrabeculectomy (PT) and phacoemulsification (phaco) both effectively lowered intraocular pressure (IOP) and improved visual acuity (VA) in Tanzanian patients with primary open angle glaucoma (POAG). PT showed slightly better IOP reduction than phacoemulsification alone.
Area of Science:
- Ophthalmology
- Glaucoma Research
- Surgical Outcomes
Background:
- Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness globally.
- Effective management of intraocular pressure (IOP) is crucial in preventing glaucoma progression.
- Surgical interventions are often necessary when medical management fails to control IOP.
Purpose of the Study:
- To compare the efficacy of phacotrabeculectomy (PT) versus phacoemulsification (phaco) alone in reducing IOP and improving visual acuity (VA).
- To evaluate the long-term outcomes of these surgical procedures in Tanzanian patients with POAG.
- To assess the comparative effectiveness of two common glaucoma surgical techniques in an African population.
Main Methods:
- A within-person observational cohort study design was employed.
- Each patient underwent both PT in one eye and phacoemulsification in the fellow eye.
- Intraocular pressure (IOP) and visual acuity (VA) were assessed over a follow-up period of up to 5.5 years.
Main Results:
- Both PT and phacoemulsification significantly reduced IOP and improved VA (p<0.001) in patients with at least 250 days of follow-up.
- Phacotrabeculectomy (PT) resulted in a greater average IOP reduction (50%) compared to phacoemulsification (41%).
- Mean IOP was significantly lower after PT (12.9 mm Hg) than after phacoemulsification (16.8 mm Hg) (p=0.004).
Conclusions:
- Phacotrabeculectomy (PT) demonstrated superior IOP-lowering effects compared to phacoemulsification alone in this cohort of African patients, although the difference was modest.
- Phacoemulsification alone proved effective in reducing IOP and enhancing VA for several years.
- The relative simplicity of phacoemulsification makes it a viable surgical option for managing POAG in certain clinical settings.